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News

Liver transplantation for hepatocellular carcinoma - tumor size not so important

Moderate expansion of current tumor size limits does not adversely impact survival after liver transplantation for hepatocellular carcinoma, claims a team from San Francisco, California, USA.

News image

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The researchers investigated the outcome of patients with cirrhosis and hepatocellular carcinoma (HCC) who underwent orthotopic liver transplantation (OLT).

They reported their findings in the June issue of Hepatology.

70 consecutive patients, who underwent orthotopic liver transplantations over a 12-year period, were enrolled into the study.

The current criteria for OLT, based on tumor size, may be expanded modestly,
Dr Francis Y. Yao

Pathologic tumor staging of the explanted liver was based on the American Tumor Study Group modified Tumor-Node-Metastases (TNM) Staging Classification.

Tumor recurrence was found to occur in 11% of patients after transplantation.

The Kaplan-Meier survival rates at 1 and 5 years were 91% and 72%, respectively, for patients with pT1 or pT2 HCC. Patients with pT3 tumors had survival rates of 82% and 74%, respectively.

Patients with pT4 tumors, however, had a significantly worse 1-year survival of 33%.

An alpha-fetoprotein (AFP) level greater than 1,000 ng/mL was found to be a significant predictor for reduced survival in univariate analysis. Other predictors of reduced survival were a total tumor diameter greater than 8 cm, age over 55 years, and poorly differentiated histologic grade.

Only pT4 stage and total tumor diameter remained statistically significant in multivariate analysis.

Patients with HCC meeting certain criteria had survival rates of 90% and 75%, at 1 and 5 years, respectively, after OLT. The criteria were a solitary tumor less than 6.5 cm, or fewer than 3 nodules, with the largest lesion less than 4.5 cm and total tumor diameter less than 8 cm.

Those subjects with tumors exceeding these limits had a 50% 1-year survival rate.

Dr Francis Y. Yao, of the University of California, San Francisco, concluded on behalf of fellow authors, "The current criteria for OLT based on tumor size may be modestly expanded, while still preserving excellent survival after OLT."

Hepatology 2001; 33: 1394-1403
07 June 2001

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